Sports betting became legalized nationwide in 2018 with the U.S. Supreme Court decision, Murphy v. National Collegiate Athletic Association. Since then, sportsbooks, in-person or online platforms for betting on sporting events, have become very popular.

But what about the public health effects of gambling addiction? It is often overlooked in research, clinical practice and public policy.

Researchers from the University of California at San Diego School of Medicine and Qualcomm Institute there wanted to document the increase of sports betting in the U.S. after the Murphy v. NCAA decision. The number of states allowing operational sportsbooks went from one in 2017 to 38 in 2024, they found. The dollar volume of sports bets rose from $4.9 billion in 2017 to $121.1 billion in 2023, an increase of over 2300 percent.

After online sportsbooks and apps launched, searches related to gambling and addiction increased by 61 percent. Between 2017 and 2023, the dollar volume of sports bets rose over 2300 percent.

“Sports betting has become deeply embedded in our culture,” Matthew Allen, a coauthor of the study and a third-year medical student at UC San Diego, said in a statement. Sports betting was once taboo, he explained, but now it has become normalized.

The study was designed to collect data about how the widespread availability of sportsbooks might affect the rate of gambling addiction in the U.S. The researchers analyzed trends in Google searches that mentioned terms like “gambling,” “addiction,” “addict,” “anonymous” and “hotline.” The number of searches for these terms increased 23 percent in the six years between the NCAA v. Murphy decision in 2018 and June 2024.

“Many people who are struggling with addiction don't openly discuss it, but they do turn to the Internet for answers,” Davey Smith, a co-author of the paper and a professor of medicine at UC San Diego, said in a statement.

By state, the number of searches related to help for gambling addiction rose along with the opening of sportsbooks. The three states that saw the biggest increase in gambling addiction searches were Ohio (a 67 percent increase), Pennsylvania (a 50 percent increase) and Massachusetts (a 47 percent increase).

The launch of online sportsbooks and smartphone apps caused a bigger increase in help-seeking searches than the arrival of brick-and-mortar sportsbooks. The convenience of online betting is likely the reason for this, the researchers believe.

After traditional sportsbooks debuted in Pennsylvania, for example, searches related to gambling and addiction increased by 33 percent in the five months before online sportsbooks and apps launched. After they launched, however, searches related to gambling and addiction increased by 61 percent.

Sports betting is not the only reason searches related to gambling and addiction are increasing. There is more opportunity to bet in general: Some casinos now offer traditional casino games online.

The question becomes what to do about it, John Ayers, senior author on the paper, an adjunct assistant professor at UC San Diego and a research scientist at the Qualcomm Institute, told TheDoctor.

Sports betting is not the only reason searches related to gambling and addiction are increasing. There is more opportunity to bet in general: Some casinos now offer traditional casino games online.

Ayers suggests several ways online gambling could be curbed:

  • Pass regulations restricting how sportsbooks are advertised, similar to those governing alcohol and tobacco advertisements.
  • Add stronger safeguards for online sportsbooks, such as age limits, betting limits, enforced breaks from betting and restrictions on credit card use.
  • Increase funding for gambling addiction services using sportsbook tax revenues. Of the 38 states where sports gambling is legal, only Wyoming allocated funding for gambling addiction services in the same piece of legislation that legalized sportsbooks. The state allocated just $300,000.
  • Train clinicians to identify gambling addiction. There is currently no clinical protocol for the treatment of gambling addiction. Instead, treatments for other addictions are being used off-label to treat gambling addiction.
  • Finally, talk to loved ones if you believe they have a gambling problem. “Let's stop the problem before your loved one has fallen over the cliff,” said Ayers. Help them find established resources, such as gambling addiction hotlines and healthcare professionals who specialize in treating gambling addiction.

The study and a related editorial are published in JAMA Internal Medicine.